Biopsy with local Urologist or MD Anderson

DesignatedDriver · New User Joined: 28 Oct 2009 Posts: 5

This is the wife, hence the Designateddriver name. DH has been referred to urologist due to PSA going from 2.8 to 4.4 in one year.

He is 55, in good health, but has had problems he's attributed to an enlarged prostate, mainly takes a long time to start peeing, and I think he has to strain a bit. No family history. general Doctor found enlarged, but nothing else.

Question1: Please tell me that it is still very possible it PSA can be attributed to BPH
Q2: If local guy says to do biopsy-- is it better to have him do it, or should we just start everything at MD Anderson in Houston? Local would be easiest, and if they are the same I'd do it close to home (we are in DFW area)
Q3: Should I push for one month anti-biotics and re-test before biopsy?
Thanks!
Also I'm confused as to importance of a big jump in PSA, one article said morel likely to be cancer, another (the one I like) said more likely BPH.

johnT · Senior User Joined: 27 Apr 2009 Posts: 176

I would get a free PCA and a PCA3 test before a biopsy; if these are abnormal then I would get a biopsy. Local is OK for the 1st biopsy. If additional biopsies are required I would absolutely get a color doppler untrasound targeted biopsy.
Yes, PSA can rise rapdily because of an infection. Having an enlarged prostate will cause psa to rise; but slower than .75ngl/year
JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

DesignatedDriver · New User Joined: 28 Oct 2009 Posts: 5

JohnT--Thanks for quick reply. Will send DH to appt with request for the blood work first. Question about the color doppler ultrasound thingy--why don't they do that one first? Is that available to most urologists's offices? And is an enlarged prostrate considered an abnormal finding? Here's to hoping I get nothing but good news for hubby after his appt.

Otago · Experienced user Joined: 20 Jan 2008 Posts: 64

[quote]Question1: Please tell me that it is still very possible it PSA can be attributed to BPH[/quote]

Possible, but with the 2.8 to 4.4 its more likely from some form of prostatitis than BPH.

[quote]Q2: If local guy says to do biopsy-- is it better to have him do it, or should we just start everything at MD Anderson in Houston? Local would be easiest, and if they are the same I'd do it close to home (we are in DFW area)[/quote]

Local guy could be fine.

[quote]
Q3: Should I push for one month anti-biotics and re-test before biopsy?
Thanks!
Also I'm confused as to importance of a big jump in PSA, one article said morel likely to be cancer, another (the one I like) said more likely BPH.[/quote]

I'd say, unless something unusual is found on the digital exam the urologist makes, then there should certainly be a follow-up PSA prior to any biopsy.
Don't get pushed into a biopsy just because of one raised test result.

He should undergo a course of antibiotics and ibuprofen or other anti-inflammatory.
You need to realize that most prostatitis is NOT from a infection, but from other causes, and that often it can be a asymptomatic prostatitis.
Sometimes just waiting a couple months, taking nothing at all, can allow the prostate to calm down.
Or the antibiotics or anti-inflammatory medication can do the same.

Take a look at this page

http://prostate-help.org/psa.html

Lastly, a PSA jump, more likely cancer or BPH..?
Actually more likely to be neither, but instead be just some version of prostatitis (which again, need not be a bacterial infection).
You have to realize that antibiotics only tend to work if there is a bacterial infection. Again, most prostatitis is not bacterial in nature, yet can cause a significant rise in PSA.

Otago

johnT · Senior User Joined: 27 Apr 2009 Posts: 176

BPH is not considered abnormal.
Most urologists won't refer for a color doppler. It's done by interventonal radiologists and urologists think that they should be the only ones doing biopsies.
The best color doppler guys are Fred Lee in Rochested MI and Duke Bahn in Ventura Ca. The Dattoli center in Sarosta Fla also does them. It's well worth the travel to get one.
JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

DesignatedDriver · New User Joined: 28 Oct 2009 Posts: 5

Thanks again John T and thanks Otago. Guess I have a lot to learn. I wasn't researching prostatitis at all cos I thought he'd have pain associated with that. Good news that that could be it. I tend to jump to worst conclusions, and so far, thank God, I've always been wrong. He should've been going to the urologist anyway due to the other issues, so he's hoping they can improve that situation.

DesignatedDriver · New User Joined: 28 Oct 2009 Posts: 5

DH had initial visit with urologist today. He found enlarged prostate but nothing else. He has recommended biopsy due to the PSA rise. They did take urine sample but before DRE so I don't think it is the PCA3 test. Dr said it was not prostatitis. He said DH has a 70 % chance it is not cancer. He said DH symptoms were consistent with enlarged prostate.

DH scheduled the biopsy. He is the kind of guy to trust the specialist he was referred to and doesn't want to ask any questions. Is it worth me rocking the boat and calling the MD? What tests will the urine show?

Jean222 · Senior User Joined: 14 Dec 2008 Posts: 249

Hi,

The urine tests will show infection, protein & sugar levels.

First thing they look for is infection, easy to treat with anti-biotics.

Good news that the doc thinks he's got a 70% chance of NOT having cancer, fingers crossed it's something easy to sort out.

Best to have the biopsy and be certain it's not cancer. IMO.

DesignatedDriver · New User Joined: 28 Oct 2009 Posts: 5

Thanks Jean, I now realize that I don't have control over DH decision making and he is choosing to not buck the Dr's suggestion, so biopsy it is. I have been reading a lot about it and he wants to hear nothing about it from me. (no surprise, he's always been queasy about any medical stuff) Ok by me, who wants to hear particulars about cancer if you don't need to know and so far, we don't need to. I hope my next post is all good news.

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